Individual
JADA COY-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
638 BENNINGTON ST, EAST BOSTON, MA 02128-1576
(857) 256-2508
Mailing address
194 WALNUT AVE, ROXBURY, MA 02119-1614
(857) 492-8324
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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